Serum IgE (total and five specific) and eosinophil cationic protein (ECP) levels were compared in elderly physician-diagnosed patients with asthma with non-asthmatic controls matched by age and gender to ascertain whether elevated levels are indicators of asthma in the elderly. All subjects and controls were non-smokers. The subjects were participants in the Florida Geriatric Research Program (FGRP), a longitudinal aging study that tracks the health status of people 65 years and older. Frozen sera from 33 randomly selected asthmatic patients and 21 controls, none of whom had any other chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD), all between the ages of 65 and 90, were assessed for total IgE; five specific IgE concentrations (for cat, ragweed, German cockroach, Dermatophagoides pteronyssinus (Dp) and live oak); and ECP levels using the Pharmacia Unicap System. The odds of an elderly asthmatic patient having a total IgE of > 100 KU/L were higher than that for a non-asthmatic patient (odds ratio (OR) = 13.0; Mantel-Haenszel (MH) p = 0.005). The odds of elderly asthmatic patients having at least one positive serum specific IgE compared to elderly age-matched non-asthmatic patients were higher (OR = 21.2; MH p = 0.001). Among the five specific IgE concentrations, only IgE for Dp was higher in asthmatic than in non-asthmatic patients (OR = 13.00; MH p = 0.005). The ECP level was not significantly different between elderly asthmatic and non-asthmatic patients (asthmatic mean = 20.7 microg/L, SE = 0.48; control mean = 19.5 microg/L. SE = 0.76) (mean for younger adults 4.4 microg/L, Pharmacia Diagnostics). The serum of elderly asthmatic patients is more likely to have elevated total IgE and a positive specific IgE to Dp. ECP is elevated in elderly subjects but is not an indicator of asthma.
"The most common aeroallergen to which older patients with asthma are sensitized is not consistent among reports, but includes cat , dust mites [92,95], and cockroach . Whether the differences in specific antigen sensitization are due to socioeconomic status, geographic location and environmental exposures, is not well established at the present. "
[Show abstract][Hide abstract] ABSTRACT: In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
World Allergy Organization Journal 05/2014; 7(1):16. DOI:10.1186/1939-4551-7-16
"Most patients with allergic symptoms from mucosal membranes in the airways and gastrointestinal tract, express IgE antibodies to allergens and the allergy is said to be IgEmediated . Total serum IgE concentrations tend to be higher in allergic individuals compared to nonallergic adults and children, but the diagnostic relevance is limited as a screening test for allergic disease (Klink et al. 1990, King et al. 2004). Allergen-specific IgE antibodies in atopic individuals originate from a broad variety of B cells reflecting the activation of multiple B-cell clones during allergen sensitization (Eibensteiner et al. 2000). "
[Show abstract][Hide abstract] ABSTRACT: Transforming growth factor β signalling through Smad3 in allergy Allergic diseases, such as atopic dermatitis, asthma, and contact dermatitis are complex diseases influenced by both genetic and environmental factors. It is still unclear why allergy and subsequent allergic disease occur in some individuals but not in others. Transforming growth factor (TGF)-β is an important immunomodulatory and fibrogenic factor that regulates cellular processes in injured and inflamed skin. TGF-β has a significant role in the regulation of the allergen-induced immune response participating in the development of allergic and asthmatic inflammation. TGF-β is known to be an immunomodulatory factor in the progression of delayed type hypersensitivity reactions and allergic contact dermatitis. TGF-β is crucial in regulating the cellular responses involved in allergy, such as differentiation, proliferation and migration. TGF-β signals are delivered from the cytoplasm to the nucleus by TGF-β signal transducers called Smads. Smad3 is a major signal transducer in TGF-β -signalling that controls the expression of target genes in the nucleus in a cell-type specific manner. The role of TGF-β-Smad3 -signalling in the immunoregulation and pathophysiology of allergic disorders is still poorly understood. In this thesis, the role of TGF-β-Smad -signalling pathway using Smad3 -deficient knock out mice in the murine models of allergic diseases; atopic dermatitis, asthma and allergic contact reactions, was examined. Smad3-pathway regulates allergen induced skin inflammation and systemic IgE antibody production in a murine model atopic dermatitis. The defect in Smad3 -signalling decreased Th2 cytokine (IL-13 and IL-5) mRNA expression in the lung, modulated allergen induced specific IgG1 response, and affected mucus production in the lung in a murine model of asthma. TGF-β / Smad3 -signalling contributed to inflammatory hypersensitivity reactions and disease progression via modulation of chemokine and cytokine expression and inflammatory cell recruitment, cell proliferation and regulation of the specific antibody response in a murine model of contact hypersensitivity. TGF-β modulates inflammatory responses - at least partly through the Smad3 pathway - but also through other compensatory, non-Smad-dependent pathways. Understanding the effects of the TGF-β signalling pathway in the immune system and in disease models can help in elucidating the multilevel effects of TGF-β. Unravelling the mechanisms of Smad3 may open new possibilities for treating and preventing allergic responses, which may lead to severe illness and loss of work ability. In the future the Smad3 signalling pathway might be a potential target in the therapy of allergic diseases. Atooppiset taudit yleistyvät - tutkimus paljastaa uutta tietoa tautien syntymekanismeista Väitöskirjatutkimuksessa on onnistuttu immuno- ja molekyylibiologisin keinoin selvittämään solunsisäisen valkuaisaineen, Smad3:n, merkitystä allergisten tautien, atooppisen astman ja ihottuman, synnylle. Tutkimuksen tulokset auttavat kehittämään allergisten tautien hoitokeinoja. Atooppiset taudit ovat kroonisia ja monitekijäisiä tiloja, jotka yleistyvät jatkuvasti. On arvioitu, että lähitulevaisuudessa kolmannes länsimaailman väestöstä tulee kärsimään näistä. Atooppinen astma on krooninen tulehduksellinen tauti hengitysteissä, jolle on tyypillistä hengitysteiden ahtautuminen, hengitysteiden yliärtyvyys, lisääntynyt limaneritys ja limakalvovaurioita. Atooppinen ihottuma, dermatiitti, on kutiava tulehdus, jota esiintyy 10-15 % kaikista länsimaailman lapsista. Tämä tila on yhteydessä muihin allergisiin tiloihin myöhemmissä elinvaiheissa. Elimistössä esiintyvä TGF-beta-valkuaisaine vaikuttaa merkittävästi allergisen tulehduksen syntyyn. Kyseistä valkuaisainetta erittyy eri solutyypeistä ja sillä on hyvin laaja vaikutuskirjo. Yleensä tämän valkuaisaineen tehtävänä elimistössä on vähentää tulehdusreaktioita. Tutkimuksessa selvitettiin TGF-beta-valkuaisaineen vaikutuksia keskeisesti välittävän solunsisäisen välittäjäproteiinin, Smad3:n, merkitystä TGF-beta-valkuaisaineen toiminnalle allergisessa tilassa. Normaalisti toimiessaan Smad3 aktivoi solun tumassa erilaisten proteiinien tuotantoa, millä on merkitystä allergisen tulehduksen syntymisessä ja etenemisessä. Tutkimuksessa on saatu uutta tietoa siitä, mitkä sytokiinit ja kemokiinit (solujen liikkeisiin vaikuttavia pienimolekyylisiä aineita) reagoivat Smad3-välittäjäaineen puuttumiseen ja sitä kautta on tullut merkittävästi tietoa atooppisen astman ja dermatiitin syntyyn vaikuttavista tekijöistä. Tämä tieto auttaa tutkijoita tehokkaampien hoitomuotojen kehittämistyössä allergisia tauteja vastaan.
[Show abstract][Hide abstract] ABSTRACT: For elderly people, epidemiological data are rare for respiratory allergies and completely missing for food allergies. The aim of this study was to examine the prevalence and risk factors for sensitizations in 109 people with a mean age of 77 years, who are living in a geriatric nursing home. The cross-sectional study included a detailed interview, skin prick tests, and serum tests for specific and total IgE, IFN-gamma, and ST2, a marker for Th2-lymphocyte activity. Almost all study subjects (n=101) suffered from co-morbidity, 14 from type I allergy, 25 from gastrointestinal disorders treated with anti-ulcer drugs, 25 were chronic alcoholics and 21 were smokers. The total IgE levels were significantly higher in men (P=0.025), and not affected by smoking or alcohol consumption. Skin prick tests were positive in 41.7% of tested patients. Specific IgE to respiratory allergens was found in 40.4% of all patients and was elevated in men (P=0.013), with a significant correlation to smoking (P=0.029). Specific IgE to food allergens was detected in 24.8%, apparently without connection to the investigated risk factors. However, positive skin prick tests with food allergens could be correlated with chronic alcohol consumption (P=0.036). The intake of anti-ulcer medication was significantly correlated with elevated ST2 levels as an indirect readout for Th2-cell activity (P<0.001). The risk factors for sensitization in elderly to respiratory allergens were chronic damage of respiratory epithelia due to smoking, and for sensitization to food allergens chronic alcohol consumption.
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